Should we rely solely on X-ray for knee osteoarthritis management?



Knee osteoarthritis is a leading cause of disability among older adults and is characterised by changes in joint structure, joint pain, mechanical joint dysfunction, and muscle weakness.


Many would have had X-ray of their painful knee to observe the integrity of their knee joint, and many will use these findings as an indicator for treatment. However, radiographic severity does not often correlate with patient symptoms. Patients with severe pain can present with minimal radiographic severity, and conversely, those with severe radiographic osteoarthritis may present with minimal symptoms. Pain, severity of disability, and other patient-specific factors should be considered in association with radiographic findings, to indicate the appropriate conservative approach.


Most patients with knee osteoarthritis demonstrate altered knee biomechanics during gait in the three-planes of movement. Any deficits in biomechanics should be represented by an individualised rehabilitation programme to optimise function and quality of life. Biomechanical markers are more associated with pain and function during activities of daily living, while imaging is more associated with symptoms.


Bensalma, F. et al. (2022). Biomechanical markers associations with pain, symptoms, and disability compared to radiographic severity in knee osteoarthritis patients: a secondary analysis from a cluster randomised controlled trial. BMC Musculoskeletal Disorders. 896: 380.